Provider Demographics
NPI:1326226291
Name:PERSONAL WELLNESS COUNSELING SERVICE, LLC
Entity Type:Organization
Organization Name:PERSONAL WELLNESS COUNSELING SERVICE, LLC
Other - Org Name:PERSONAL WELLNESS COUNSELING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:302-995-5456
Mailing Address - Street 1:3 MONASTERY LN
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-2035
Mailing Address - Country:US
Mailing Address - Phone:302-995-5456
Mailing Address - Fax:302-995-0292
Practice Address - Street 1:242 N JAMES ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NEWPORT
Practice Address - State:DE
Practice Address - Zip Code:19804-3182
Practice Address - Country:US
Practice Address - Phone:302-995-5456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0000762104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty